Analysis of serum cytokine levels in children with chronic cough associated with Toxocara canis infection.

Toxocara infection is associated with an increased prevalence of airway symptoms and may be a possible aetiologic agent of chronic cough. The occurrence of toxocariasis in Hungary is mild and/or sporadic. The purpose of this study was to investigate the levels of serum cytokines (IL-1, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, IFN-gamma and TNF-alpha) and total IgE, the blood eosinophil count, the results of skin prick and non-specific bronchus provocation tests in Toxocara-seropositive children with chronic cough relative to those in healthy controls. The patients exhibited moderate eosinophilia, significantly elevated levels of serum total IgE, IL-6, IL-10, IL-13 and IFN-gamma, and higher skin reactivity to common allergens, whereas the bronchial hyperreactivity was similar in the two groups. The protective proinflammatory cytokines (IL-6, IFN-gamma and IL-13) in association with the anti-inflammatory cytokine (IL-10) were simultaneously increased in Toxocara-infected children with chronic cough. During infections, the activation and suppression of immune processes occur simultaneously and cytokines of Th1/Th2 and regulatory T cells contribute to the regulation of the immune response evoked by helminth infections (depending on the parasite load, the timing and duration of the infection and the status of the host immune system).

Toxocariasis associated with chronic cough in childhood: a longitudinal study in Hungary.

Chronic cough lasting 8 weeks or more often seems to be an intractable problem in childhood. Toxocara infection is associated with an increased prevalence of airway symptoms and may be the possible aetiological agent of chronic cough. Of 425 children aged 2-17 years with chronic cough who were investigated for toxocariasis and the distribution of bronchial asthma (BA), cough variant asthma (CVA) and non-asthmatic eosinophilic bronchitis (NAEB), 136 (32%) were seropositive for Toxocara canis antigens. Ninety-three of the 136 were adequately assessed, diagnosed and followed up during 1 year. BA was diagnosed in 40%, CVA in 27% and NAEB in 33% of the children. The eosinophil cell count, serum T. canis IgG levels and symptoms are predictors of the improvement or the decline of the condition. Presuming the aetiopathogenetic role of T. canis in the inflammatory process of chronic cough, we treated the children not only with inhaled corticosteroid (ICS), but also with a 1-week course of anthelminthics. We could significantly decrease the dose of ICS in 23 (62%) of the 37 with BA. The administration of anthelminthics and the avoidance of sensitizers were sufficient for those with NAEB; none needed ICS. ICS therapy could be stopped 2-3 months later in 17 (68%) of the 25 with CVA. We found that 8 of the 25 with CVA (32%) presented asthmatic symptoms at the end of the 1-year period. In Hungary, T. canis may be a potential sensitizer for chronic cough in seropositive children. Deworming therapy will then alleviate the airway symptoms without exacerbation in patients with BA, and have a positive effect on those with NAEB and the majority of those with CVA.

[Epidemiology and laboratory diagnostics of legionellae]. / A legionellák epidemiológiája és laboratóriumi diagnosztikája.

The severe pulmonary disease caused by the inhalation of the different Legionella species is called Legionella pneumonia, while the name of the pulmonary disease caused by the most common Legionella (L. pneumophila) is Legionnaires' disease. Another type of disease caused by legionellae is Pontiac fever with influenza-like symptoms. Legionella spp. are facultative intracellular parasites. They survive within both monocytes in the human organism and amebae in the environment. To prevent and control the occurrence of legionelloses, legionellae should be surveyed and detected in the environmental (water pipes, air-conditioning systems, cooling towers, respiratory equipments, etc.) and clinical (blood, bronchoalveolar lavage, sputum, abscess, etc.) samples. Laboratory diagnosis is complicated by the limitations of the available assays. Thus, it is proposed that the microbiological laboratory diagnosis should be based on the simultaneous application of at least three methods (culturing [on BCYE medium], followed by biochemical assays, serology, molecular biologic methods, such as polymerase chain reaction [PCR], direct demonstration [immunofluorescence microscopy], antigen determination are the most important ones) and on the simultaneous demonstration from three different samples (e.g. lower respiratory tract secretions, sputum, urine, blood culture, serum, moreover, water samples from all potential infectious sources, sediment of hot water tanks, as well as swab samples of faucets and shower heads). The advantage of PCR is that is gives reliable results in one day, in contrast to conventional culturing. However, its sensitivity can not be improved by increasing the sample volume, and neither can it give quantitative results nor can it produce strains for epidemiologic studies, contrary to the method of culturing. It is concluded that PCR and culturing do complement, but do not substitute each other.

[Management of hydatid disease of the lung]. / A tüdó hydatid megbetegedése és kezelése.

Cystic echinococcosis is a worldwide zoonose which is not infectious from man to man occurring seldom in our country. The diagnosis and the treatment of a case of a 4-year-old girl with large left-sided lung cyst were presented. Diagnosis was based on history, clinical findings, imaging techniques (conventional X-ray examination, ultrasonography, computer tomography), eosinophilia (7-50%) in blood smear, leucocytosis (28,000), increased sedimentation of blood (85 mm/hour), significantly elevated antibody against of Echinococcus in immunodiagnostic test (passive haemagglutination) with high sensitivity and specificity, light microscopic radiological and scanning electronmicroscopic analysis of cyst content. Continuous thoracic drainage, twice percutan drainage under CT guidance and a new technique for treatment as Puncture-Aspiration-Injection-Respiration and lavage with hypertonic sodium chlorate, long-term chemotherapy with benzimidazole-carbamates (Vermox: 20 mg/kg/day, Zentel: 30-50 mg/kg/day) were reported. The cyst was grown down into a solid mass as large as 4 cm. The body-weight of this child has grown 6 kilograms and laboratory parameters were normalized.

Isolation, identification and increasing importance of 'free-living' amoebae causing human disease.

Amphizoic small amoebic protozoa are capable of existing both in 'free-living' and in 'parasitic' form depending on the actual conditions. Two genera (Naegleria and Acanthamoeba) have become recognised as opportunist human parasites. Since the first description in 1965 of a lethal case of primary amoebic meningoencephalitis (PAM) caused by Naegleria, many more (mostly lethal) cases have been reported, while granulomatous amoebic encephalitis (GAE), as well as eye (keratinitis, conjunctivitis, etc.), ear, nose, skin and internal organ infections caused by Acanthamoeba have also occurred in rapidly increasing numbers. Both pathogenic and non-pathogenic species of Naegleria and Acanthamoeba are found worldwide in water, soil and dust, where they provide a potential source of infection. Successful differential diagnosis and appropriate (specific) therapy depends on precise laboratory identification of the 'free-living' amoebae. In most cases, isolation from the environment can be achieved, but identification and differentiation of the pathogenic and non-pathogenic strains is not easy. The methods presently available do not fulfil completely the requirements for specificity, sensitivity and reliability. Morphological criteria are inadequate, while thermophilic character, pH dependency and even virulence in infected mice, are not unambiguous features of pathogenicity of the different strains. More promising are molecular methods, such as restriction endonuclease digestion of whole-cell DNA or mitochondrial DNA, as well as iso-enzyme profile analysis after iso-electric focusing and staining for acid phosphatase and propionyl esterase activity. Use of appropriate monoclonal antibodies has also yielded promising results in the differentiation of human pathogenic and non-pathogenic strains. However, quicker, simpler, more specific and reliable methods are still highly desirable. The significance of endosymbiosis (especially with Legionella strains) is not well understood. The results of a systematic survey in Hungary for the isolation and identification of 'free-living' amoebae, including an investigation of the Hungarian amoebic fauna, the isolation of possibly pathogenic Naegleria strains and of some Acanthamoeba strains from eye diseases, as well as the finding of a case of endosymbiosis, are also reported here.

Prevention of congenital toxoplasmosis in Szeged, Hungary.

BACKGROUND: Toxoplasma gondii infection of the fetus can only be discovered or prevented by the appropriate serological screening and subsequent treatment of the mother and her offspring. In Hungary, there is no obligatory toxoplasma screening for pregnant women and both the reporting and follow-up of congenital toxoplasmosis cases is limited. In 1987 we started a systematic study in the Szeged region of Hungary, in which all pregnant women were screened and appropriate treatment given to all mothers and their offspring where congenital toxoplasmosis was suspected. METHODS: All pregnant women were routinely screened within the first 16 weeks of gestation for toxoplasma antibodies by complement fixation test (CFT). Seronegative cases were retested for possible seroconversion every second month. Patients with CFT titres > or = 1:256 were retested for anti-P30 immunoglobulin A (IgA), IgM and IgG antibodies by ELISA and/or SDS-PAGE-Western immunoblot in order to distinguish the acute and chronic phases of the infection. RESULTS: Up to the end of 1994, the sera of 17,735 gravidae were screened. Ten women were found to have seroconverted during pregnancy and 78 had high initial antibody levels accompanied by anti-P30 IgA antibodies at the very first screening. These two groups together were considered as definitely (10) or possibly (78) infected with Toxoplasma during pregnancy and were treated with Spiramycin. All of their offspring were also treated for one month and followed-up by systematic serological and clinical screening for 2 years. No congenital toxoplasmosis was found in any of the offspring. CONCLUSIONS: Antenatal, early diagnosis and treatment of toxoplasmosis in mothers, together with treatment and follow-up of their offspring, may considerably reduce the incidence of the disease in the offspring.

[Serodiagnosis of toxoplasmosis]. / A toxoplasmosis szerodiagnosztikája.

Generally, toxoplasmosis has mild symptoms, or is asymptomatic, in patients with intact immune system. The infection, however, may have serious consequences in immunodeficient or immunosuppressed patients, as well as in the off-springs of pregnant women. If the mother has acute toxoplasmosis during the pregnancy, the passage of parasites through the placenta may result in the death of the fetus, or, in the severe damage of the fetus or neonate. All these consequences can be prevented by the early detection of the disease followed by the immediate therapy of the mother. Contrary to the most infectious diseases, however, the high specific IgM level has not proved to be a reliable marker of the acute infection in the case of toxoplasmosis. Therefore, in the case of infections discovered in the "plateau" period [i.e. with persistent IgM ("residual" IgM) and/or persistent high level of IgG antibody), the "acute" and the "chronic" phases can be distinguished more reliably by the detection with ELISA of the IgA antibody response to the so called P30 protein of Toxoplasma gondii. The anti-P30 IgA antibody response appears very early and generally disappears in 3-9 months. Thus, it is possible to discriminate the acute phase of the disease from the harmless chronic phase. Between 1987 and 1996, practically all pregnant women in Szeged and its region (altogether 21,952 women), underwent serologic toxoplasma screening. Among them, 124 pregnant women were found highly suspicious for having acute toxoplasmosis. Appropriate counselling, followed by spiramycin therapy during pregnancy and regular ultrasound examination were their antenatal management. No clinically manifested fetal or neonatal infection was observed. The screening and treatment schedule seems to be promising in the prevention of fetal and neonatal toxoplasmosis.

Determination and kinetics of antibody response to Candida albicans in ulcerative colitis.

Levels of antibody against the mannan component of Candida albicans cell wall were determined and followed in 57 ulcerative colitis patients. The appearance of higher titers suggests an intermittent (benign) clinical course of the disease. Lower titer values at repeated checks are associated with a continuous (severe) clinical course. Our data suggest that Candida albicans antibody titer values may be used as an indicator of the clinical outcome of ulcerative colitis.